Effective Topical Combination Therapy for Treatment of Lichen Striatus in Children: A Case Series and Review

July 2012 | Volume 11 | Issue 7 | Case Report | 872 | Copyright © 2012

Abstract

Lichen striatus (LS) is an uncommon linear dermatosis that is primarily seen in children from 4 months to 15 years of age. While some of these eruptions are asymptomatic, others can be quite pruritic. In darker-skinned individuals, post-inflammatory hypopigmentation can be significant and may provide a cause for concern for the patients and/or their parents. In our case series of 4 patients, we observed rapid resolution of LS by combining a topical retinoid with a topical steroid. To our knowledge, this is the first report of successful treatment with this kind of combination therapy in the English literature. The patients not only achieved satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of topical tazarotene is localized irritation at treatment sites, but the patients in this particular series tolerated the treatment well.

J Drugs Dermatol. 2012;11(7):872-875.

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INTRODUCTION

Lichen striatus (LS) is an uncommon linear dermatosis primarily seen in children between the ages of 4 months and 15 years. Typically, the lesions consist of pink, red, or flesh-colored flat-topped lichenoid papules arranged linearly, often along the lines of Blaschko. Lesions are usually solitary, but rare cases of multiple lesions distributed bilaterally have been reported.1-3 Lesions occur most often on the limbs, and, less frequently, on the trunk or face.4 Lichen striatus develops at a higher frequency in children with a personal or family history of atopy.5 While some of these eruptions are asymptomatic, others can be quite pruritic. Reports of associated pruritus range from 11% to 34%.5-6 Although LS is usually self-limited, it may last up to 1 to 2 years. Treatment is considered elective for either symptomatic or cosmetic concerns.7 While topical steroids are considered first-line therapy for relief of pruritus, they have not had significant effects on modulating the course or duration of LS.6 In darker-skinned individuals, post-inflammatory hypopigmentation can be significant, and may provide a cause for concern for the patients and/or their parents.

Retinoids have proven to be a successful therapy for treatment of a variety of cornification disorders and are known to modulate keratinocyte proliferation and differentiation.8 In this report, we will provide a case series of LS treated with a combination of a topical steroid and a topical retinoid. In our experience, the addition of a topical retinoid shortens the duration of the treatment and leads to earlier resolution, when compared to treatment with a topical steroid alone. This combination of topical agents also appears to be effective in improving postinflammatory dyspigmentation in patients with darker skin. The most common side effect of the treatment is mild irritation.

CASE REPORT

Case 1

An African-American girl, aged one year, presented with a linear, papular dermatitis involving the lower chin and right cheek. The rash had been present for about 2 weeks, and the onset was insidious without any known trigger. This had initially been treated with hydrocortisone and nystatin, with little improvement. Exam revealed monomorphic, 2 mm to 3 mm inflammatory papules in a Blaschkoid distribution extending from the right infraorbital area to the right buccal cheek, submandibular area, and lateral neck (Figure 1). There was minimal scale, but no crusting, erosion, or evidence of excoriation. The patient was diagnosed with inflamed LS, and desonide 0.05% ointment and tazarotene 0.05% cream were prescribed to be mixed and applied twice daily. At her 2-month follow-up visit, the patient's mother reported that within 2 weeks of starting the treatment, the LS had resolved almost completely. The treatment was subsequently discontinued, and follow-up exam revealed minimal residual hypopigmentation following Blaschko's lines on the lower chin, extending to the neck and postauricular area (Figure 2).

Case 2

An African-American boy, aged 4 years, presented with a 2 to 3-year history of an eruption that began on the right mid-back. Over time, it had progressed to involve a wide area on the back, as well as the right neck, cheek, arm, and hand. While this eruption had remained asymptomatic, the patient's mother was concerned about the increasing discoloration on his face. Examination revealed multiple-grouped, hypopigmented macules and flat-topped papules without erythema or scale in a Blaschkoid distribution. The patient was initially diagnosed with Blaschkoid hypomelanosis, with differential diagnoses

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